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General NPI Number Information
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NPI Number | 1710218094
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Entity Type | Organization
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Legal Business Name | MILLENNIUM ANESTHESIOLOGY CONSULTANTS, LLC
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 6800 STATE ROUTE 162
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City | MARYVILLE
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State | IL
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Zip | 62062-8500
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Country | US
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Telephone | 618-391-5589
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Fax | 214-301-0649
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Provider Business Mailing Address
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Address Line | PO BOX 616
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-0616
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Country | US
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Telephone | 833-749-8324
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Fax | 214-301-0649
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Authorized Official
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Title or Position | PRESIDENT
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Name | FREDERICK WAGNER
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Credential | MD
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Telephone | 618-391-5589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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